Antihypertensives
Which of the following best describes the mechanism of action of ACE inhibitors?
A. Block beta-adrenergic receptors
B. Inhibit the conversion of angiotensin I to angiotensin II
C. Promote sodium and water retention
D. Increase heart rate and contractility
B. Inhibit the conversion of angiotensin I to angiotensin II
Rationale: ACE inhibitors block the conversion of angiotensin I to angiotensin II, leading to vasodilation and decreased blood pressure.
The normal range for potassium is?
3.6-5.2 mmol/L
Which laboratory test is used to monitor therapy with heparin?
A. INR
B. PT
C. aPTT
D. CBC
C. aPTT
Rationale: aPTT (activated partial thromboplastin time) measures the effectiveness of heparin therapy.
Which medication’s levels may increase when given with amiodarone?
A. Metformin
B. Digoxin
C. Insulin
D. Ibuprofen
B. Digoxin
Which lipoprotein is known as “bad cholesterol”?
A. HDL
B. LDL
C. VLDL
D. Triglycerides
B. LDL
Rationale: LDL transports cholesterol through blood and contributes to plaque buildup.
First-line treatment for iron-deficiency anemia is:
A. Erythropoietin (EPO)
B. Vitamin B12 injections
C. Oral ferrous sulfate
D. Folic acid
C. Oral ferrous sulfate
Which clinical sign supports dehydration?
A. Bounding pulse
B. Jugular vein distention
C. Dry mucous membranes
D. Crackles in lungs
C. Dry mucous membranes
Rationale: Dry mucosa is a classic dehydration sign.
Which antihypertensive drug is contraindicated in pregnancy?
A. Methyldopa
B. Labetalol
C. ACE inhibitors
D. Hydralazine
C. ACE inhibitors
Rationale: ACE inhibitors are category X and can cause fetal renal damage and death.
Which side of heart failure is associated with pulmonary symptoms like crackles and dyspnea?
A. Right-sided HF
B. Left-sided HF
C. Diastolic HF
D. High-output HF
B. Left-sided HF
Rationale: Left-sided heart failure causes pulmonary congestion and dyspnea due to fluid backup into the lungs.
Which of the following statements about warfarin is true?
A. It works immediately after administration
B. It blocks vitamin K–dependent clotting factor synthesis
C. It is safe in pregnancy
D. It dissolves existing clots
B. It blocks vitamin K–dependent clotting factor synthesis
Rationale: Warfarin inhibits vitamin K–dependent clotting factor synthesis; onset is delayed due to existing factors.
Which mechanism best describes many antidysrhythmics?
A. Speed conduction
B. Slow conduction
C. Increase irritability
D. Stimulate SA node
B. Slow conduction
Rationale: Many antidysrhythmics slow electrical conduction.
Which organ is most affected by statin therapy and must be monitored?
A. Kidney
B. Pancreas
C. Liver
D. Lungs
C. Liver
Which patient finding is an expected side effect of iron therapy?
A. Purple rash
B. Black, tarry stools
C. Excessive urination
D. Bradycardia
B. Black, tarry stools
A patient presents with dehydration after persistent vomiting and diarrhea. Which IV fluid should the nurse expect to administer first?
A. 0.9% Normal saline (NS)
B. D5W
C. 3% hypertonic saline
D. 0.45% NS
A. 0.9% Normal saline (NS)
Rationale: Isotonic fluids are first-line for fluid loss from diarrhea and vomiting.
Which patient should avoid beta-blockers?
A. Patient with hypertension
B. Patient with asthma
C. Patient with angina
D. Patient post-MI
B. Patient with asthma
Rationale: Non-selective beta-blockers may cause bronchoconstriction and are contraindicated in asthma.
A nurse should withhold digoxin and notify the provider if the apical pulse is:
A. Above 100 bpm
B. Below 60 bpm
C. Between 60–100 bpm
D. Irregular for 10 seconds
B. Below 60 bpm
Rationale: Digoxin slows the heart rate; hold if apical pulse <60 bpm to prevent bradycardia.
A patient on heparin reports blood in the urine. The nurse should:
A. Document as normal
B. Hold the heparin and notify the provider
C. Give an extra dose
D. Encourage fluids
B. Hold the heparin and notify the provider
Rationale: Blood in urine is a sign of bleeding—anticoagulation should be reassessed.
Which rhythm is most commonly associated with a pulseless emergency requiring defibrillation?
A. SVT
B. Atrial fibrillation
C. Ventricular tachycardia
D. Sinus tachycardia
C. Ventricular tachycardia
Rationale: V-tach is often pulseless and progresses to death if untreated.
Patient teaching for bile acid sequestrants includes:
A. May cause constipation
B. Take with fat-soluble vitamins
C. Can decrease absorption of some vitamins
D. Take with other meds at the same time
E. Monitor for bruising (Vit K deficiency)
A. May cause constipation
C. Can decrease absorption of some vitamins
E. Monitor for bruising (Vit K deficiency)
Rationale: They affect fat-soluble vitamin absorption (A,D,E,K).
Erythropoietin is produced by the:
A. Liver
B. Bone marrow
C. Kidneys
D. Spleen
C. Kidneys
Rationale: Kidneys secrete erythropoietin to stimulate RBC production.
A patient receiving 3% saline becomes confused and hypertensive. What should the nurse do first?
A. Increase the infusion rate
B. Stop the infusion and notify the provider
C. Administer an isotonic solution
D. Document findings and continue
B. Stop the infusion and notify the provider
Rationale: 3% saline is hypertonic and must be used very carefully due to risk of fluid overload and neurologic complications.
Select All that Apply...
The nurse is reviewing side effects of ACE inhibitors. Which should be included?
A. Dry cough
B. Hyperkalemia
C. Hypoglycemia
D. Hypotension
E. Angioedema
A. Dry cough
B. Hyperkalemia
D. Hypotension
E. Angioedema
Rationale: Common side effects include cough, hyperkalemia, hypotension, and angioedema.
Which of the following are symptoms of left-sided heart failure?
A. Crackles in lungs
B. Orthopnea
C. Jugular vein distention
D. Dyspnea on exertion
E. Peripheral edema
A. Crackles in lungs
B. Orthopnea
D. Dyspnea on exertion
Rationale: Left HF causes pulmonary congestion symptoms like crackles and dyspnea.
Select all that apply...
Which are signs of bleeding that require immediate attention?
A. Black, tarry stools
B. Petechiae
C. Bruising
D. Hematuria
E. Decreased appetite
A. Black, tarry stools
B. Petechiae
C. Bruising
D. Hematuria
Rationale: These indicate internal or external bleeding due to anticoagulation.
Which symptoms require immediate follow-up in a patient taking amiodarone?
A. Cough
B. Shortness of breath
C. Vision changes
D. Photosensitivity
E. Bradycardia
A. Cough
B. Shortness of breath
C. Vision changes
E. Bradycardia
Which symptoms require immediate provider notification in a patient taking statins?
A. Muscle pain
B. Dark urine
C. Fatigue
D. Yellowing of eyes/skin
E. Mild headache
A. Muscle pain
B. Dark urine
D. Yellowing of eyes/skin
Rationale: Indicative of liver damage or rhabdomyolysis.
Folate supplementation is important because folate is required for:
A. Iron absorption in the intestine
B. DNA synthesis and RBC production
C. Anticoagulation regulation
D. Bone healing
B. DNA synthesis and RBC production
Rationale: Folate is essential for DNA synthesis and RBC formation.
Which diuretic is safest in early renal disease due to renal vasodilation?
A. Acetazolamide
B. Mannitol
C. HCTZ
D. Spironolactone
B. Mannitol
Rationale: Mannitol can aid early renal disease but NOT severe disease.
Which assessments are important for a patient on beta-blockers?
A. Heart rate
B. Respiratory rate
C. Blood glucose
D. Bowel sounds
E. Blood pressure
A. Heart rate
B. Respiratory rate
E. Blood pressure
Rationale: Beta-blockers decrease HR and BP; nonselective agents can affect respiratory function.
The nurse should include which points in teaching for a patient on digoxin?
A. Take at the same time every day
B. Skip a dose if feeling well
C. Report palpitations or dizziness
D. Check pulse before each dose
E. Double the dose if missed
A. Take at the same time every day
C. Report palpitations or dizziness
D. Check pulse before each dose
Rationale: Take consistently, monitor pulse, and report irregularities—never skip or double doses.
Heparin-induced thrombocytopenia (HIT) is characterized by:
A. Platelet count <150,000
B. Platelet count drops >50% from baseline
C. Paradoxical clot formation
D. Need to continue heparin
E. Switching to a non-heparin anticoagulant
A. Platelet count <150,000
B. Platelet count drops >50% from baseline
C. Paradoxical clot formation
E. Switching to a non-heparin anticoagulant
Rationale: HIT requires stopping heparin and using another anticoagulant such as argatroban.
What are common triggers of sinus tachycardia?
A. Fever
B. Exercise
C. Dehydration
D. Hypothermia
E. Hyperthyroidism
A. Fever
B. Exercise
C. Dehydration
A patient on statins complains of severe muscle pain and dark urine. The nurse should suspect:
A. Allergic reaction
B. Rhabdomyolysis
C. Kidney stones
D. GI bleeding
B. Rhabdomyolysis
Rationale: Dark urine + muscle pain signals muscle breakdown (rhabdomyolysis).
Which populations may receive EPO therapy?
A. CKD/ESRD patients
B. Cancer patients
C. HIV patients
D. Iron overdose patients
E. Pregnant patients only
A. CKD/ESRD patients
B. Cancer patients
C. HIV patients
Rationale: EPO used for CKD, cancer, HIV anemia—not iron overdose.
Which are loop diuretic considerations? (Select all that apply)
A. Works at ascending loop of Henle
B. Risk of hypokalemia
C. Safe with sulfa allergy
D. Used for CHF and cirrhosis
E. Can cause electrolyte loss
A. Works at ascending loop of Henle
B. Risk of hypokalemia
D. Used for CHF and cirrhosis
E. Can cause electrolyte loss
Rationale: Loop diuretics CANNOT be given with sulfa allergy.
A patient is prescribed losartan. Which lab value is most concerning?
A. Sodium 138
B. Potassium 5.8
C. Creatinine 0.9
D. Glucose 90
B. Potassium 5.8
Rationale: Hyperkalemia is a potential complication of ARBs.
Which medications are known to block the RAAS system and reduce heart failure symptoms?
A. Enalapril
B. Losartan
C. Digoxin
D. Metoprolol
E. Spironolactone
A. Enalapril
B. Losartan
E. Spironolactone
Rationale: ACE inhibitors, ARBs, and aldosterone antagonists (spironolactone) suppress RAAS.
The nurse recognizes the following drugs as antiplatelet agents:
A. Clopidogrel
B. Ticagrelor
C. Aspirin
D. Heparin
E. Warfarin
A. Clopidogrel
B. Ticagrelor
C. Aspirin
Rationale: These drugs inhibit platelet aggregation; heparin and warfarin are anticoagulants.
A patient with A-fib may require:
A. Rate control
B. Rhythm control
C. Defibrillation always
D. Anticoagulation
E. Vagal maneuvers
A. Rate control
B. Rhythm control
D. Anticoagulation
Rationale: A-fib requires rate/rhythm control + anticoagulation, not vagal maneuvers.
A drug that can lower LDL and triglycerides and raise HDL belongs to which category?
A. Statins
B. Fibrates or niacin-like class
C. Bile sequestrants only
D. PCSK9 inhibitors only
B. Fibrates or niacin-like class
Rationale: A class exists that raises HDL and lowers LDL/TG (ex: fibrates/niacin).
Teaching points for patients on iron include:
A. Expect stools to be dark
B. Avoid tea and coffee near dose
C. Take with vitamin C
D. Stop if GI upset occurs
E. Use straw for liquid iron
A. Expect stools to be dark
B. Avoid tea and coffee near dose
C. Take with vitamin C
E. Use straw for liquid iron
Rationale: Expected side effects don’t require stopping therapy.
A patient on spironolactone should avoid which foods? (Select all that apply)
A. Bananas
B. Potatoes
C. Salt substitutes
D. Oranges
E. Bread
A. Bananas
B. Potatoes
C. Salt substitutes
D. Oranges
Rationale: K-sparing diuretics increase potassium → avoid high-K foods and salt substitutes.